Introduction ______________________________________________ i
Volume 3, Fabricating Removable and Orthodontic Appliances, contains modules on such procedures as fabricating mouthguards, fluoride carriers, interim removable partial dentures, temporomandibular joint dysfunction (TMD) appliances, periodontal stents, surgical splints, complete and removable partial denture bases, space maintainers, Hawley retainers, relining removable prostheses, and rebasing complete dentures. This QTP is designed to enhance 5- and 7-skill level OJT of dental laboratory personnel. The 4Y0X2 Career Development Course may be used to compliment the training references listed in each module. All four QTPs are intended to be used by trainees, trainers, supervisors, and task certifiers. QTPs are designed to help you conduct and evaluate your field training. Once you begin upgrade training you are required to use the QTPs. QTPs provide continuity to the trainee’s upgrade training and are divided into the following volumes: 1) General Skills; 2) Fabricating Fixed Restorations; 3) Fabricating Removable and Orthodontic Appliances; and 4) Administration and Management. The QTP modules were written to assist you in preparing for and conducting training. You must use the QTP modules for training when either: 1) the STS task is a core task (minimum qualification for the specialty); or 2) you have identified the STS task as a requirement of the trainee’s job. Each module segments the major tasks into teachable elements. Your goal is to provide enough training and guidance so trainees can do all task related steps, without assistance, and produce an appliance that meets local requirements for speed and accuracy. QTPs also aid OJT task certifiers in evaluating the trainee’s demonstrated performance. If you have local training requirements not covered by a QTP module you should develop “steps in performance” and “performance checklists” that support and standardize those tasks. Accompanying each volume of QTPs is a qualification training progress record. This QTP record serves as a document to record the date the trainee completes each module. Every person in qualification/upgrade training must have this QTP progress record filed in their OJT folder. Use and annotation of this progress record is similar to current OJT documentation. When you are satisfied the trainee meets standards, as prescribed in the QTP performance checklist, you must document and initial each task completion date in column 2B of the Specialty Training Standard (STS) and the “date completed” column in the QTP progress record. If a person is being recertified on a task that is supported by a QTP you must use that module to complete the recertification process. It is not necessary to produce multiple hard copies of the QTP modules; however, your workcenter requirements may require additional copies. Regardless, you should file the QTPs in an accessible location. Typically, you will manage each module by first, training the tasks and then, evaluating performance. Your local steps in performance may vary from the method listed in the QTP module. If this is the case, you are authorized to make changes to the first half of each module, (i.e. steps in task performance); however, the “performance checklist” is considered a standard and cannot be altered. You may train each QTP volume/module in any sequence; however, when conducting training

ii_____________________________________ Introduction Continued
use an organized and methodical approach. This will reduce your training time and enhance your efforts. When beginning any training process you should first, review the procedures in each module with the trainee. Second, direct the trainee to review the training references listed to prepare for task performance. Third, go through the steps in task performance with the trainee, allowing enough time to adequately train each step (some modules may take longer to teach). Fourth, evaluate the trainee’s work at each critical step--using the performance checklist at this point will be helpful. Fifth, evaluate the trainee’s performance and provide feedback on any areas for improvement. Finally, when the trainee has successfully completed the task you must document and initial both the STS and the QTP progress record. If the trainee does not accomplish the module, conduct follow-up instruction until the trainee successfully completes the task. The QTP project goal of the 381 TRS, Sheppard AFB TX, is to publish a useable document for trainers and trainees. You are encouraged to write-in changes or revisions to the QTPs. A corrections/improvements letter is located on the last page of each QTP volume. You may choose to call in your recommendations to DSN 7367008 or FAX DSN/Commercial 736-6928 or (817) 676-6928 or email the author at mark.cochrane@sheppard.af.mil. The inclusion of names of any specific commercial product, commodity, or service in this publication is for informational purposes only and does not imply endorsement by the Air Force.

INSTRUCTIONS: The trainee must be able to construct athletic mouthguards and fluoride carriers and satisfactorily perform all tasks without assistance. Ensure proper safety precautions are followed. Evaluate the trainee’s performance using this checklist. FABRICATING ATHLETIC MOUTHGUARDS AND FLUORIDE CARRIERS DID THE TRAINEE…? 1. Prepare cast for vacuum forming the mouthguard/fluoride material 2. Properly heat the mouthguard/fluoride material to ensure proper adaptation and thickness 3. Cut the mouthguard/fluoride material to design 4. Smooth the borders without deforming the material 5. Disinfect the mouthguard or fluoride carrier FEEDBACK: Using this checklist as a source of information, discuss the trainee's performance indicating strengths and weaknesses, suggested improvements, etc. If the trainee performed all steps of the task satisfactorily, both the trainer and trainee should certify performance by appropriately documenting the OJT record. YES NO

FEEDBACK: Using this checklist as a source of information, discuss the trainee's performance indicating strengths and weaknesses, suggested improvements, etc. If the trainee performed all steps of the task satisfactorily, both the trainer and trainee should certify performance by appropriately documenting the OJT record.

10________________________________________________VOLUME 3 MODULE 3. FABRICATING TEMPOROMANDIBULAR JOINT DYSFUNCTION (TMD) APPLIANCES PERFORMANCE CHECKLIST
INSTRUCTIONS: The trainee must be able to construct a TMD appliance and satisfactorily perform all parts of the task without assistance. Ensure proper safety precautions are followed. Evaluate the trainee’s performance using this checklist. FABRICATING HARD NIGHT GUARDS DID THE TRAINEE…? 1. Verify accuracy of casts and mounting 2. Wax up (or sprinkle) the TMD appliance to the pin setting established by the provider 3. Flask and boil-out TMD appliance, ensuring there is no damage to the mold 4. Apply separator and pack the mold IAW manufacturer’s directions 5. Cure acrylic resin using proper time and temperature 6. Deflask TMD appliance without breaking cast or appliance 7. Remount cast on articulator and reestablish desired occlusal relationship 8. Recover, finish, and polish the appliance, producing smooth, hygienic surfaces 9. Disinfect the appliance FEEDBACK: Using this checklist as a source of information, discuss the trainee's performance indicating strengths and weaknesses, suggested improvements, etc. If the trainee performed all steps of the task satisfactorily, both the trainer and trainee should certify performance by appropriately documenting the OJT record. YES NO

INSTRUCTIONS: The trainee must be able to fabricate a clear acrylic resin periodontal stent and satisfactorily perform all parts of the task without assistance. Ensure proper safety precautions are followed. Evaluate the trainee’s performance using this checklist. FABRICATING PERIODONTAL STENTS DID THE TRAINEE…? 1. Verify accuracy of cast 2. Design stent correctly 3. Block out undesirable undercuts before applying acrylic resin 4. Sprinkle the acrylic resin, ensuring adequate coverage and bulk for finishing, 5. Ensure the acrylic resin is dense and completely cured 6. Remove the stent from the cast without breaking or warping it 7. Properly finish and polish the stent as per provider’s instructions 8. Disinfect the stent FEEDBACK: Using this checklist as a source of information, discuss the trainee's performance indicating strengths and weaknesses, suggested improvements, etc. If the trainee performed all steps of the task satisfactorily, both the trainer and trainee should certify performance by appropriately documenting the OJT record. YES NO

INSTRUCTIONS: The trainee must be able to fabricate a clear acrylic resin surgical splint and satisfactorily perform all parts of the task without assistance. Ensure proper safety precautions are followed. Evaluate the trainee’s performance using this checklist. FABRICATING SURGICAL SPLINTS DID THE TRAINEE…? 1. Verify accuracy of cast 2. Block out undesirable undercuts before applying acrylic resin 3. Sprinkle the acrylic resin, ensuring adequate coverage and bulk for finishing 4. Ensure the acrylic resin is dense and completely cured 5. Remove the surgical splint from the cast without breaking or warping it 6. Properly finish and polish the surgical splint as per provider’s instructions 7. Disinfect the surgical splint FEEDBACK: Using this checklist as a source of information, discuss the trainee's performance indicating strengths and weaknesses, suggested improvements, etc. If the trainee performed all steps of the task satisfactorily, both the trainer and trainee should certify performance by appropriately documenting the OJT record. . YES NO

18________________________________________________VOLUME 3 MODULE 6. CONSTRUCTING RECORD BASES AND OCCLUSAL RIMS PERFORMANCE CHECKLIST
INSTRUCTIONS: The trainee must be able to accurately construct record bases and occlusal rims and satisfactorily perform all parts of the task without assistance. Ensure proper safety precautions are followed. Evaluate the trainee’s performance using this checklist. CONSTRUCTING RECORD BASES AND OCCLUSAL RIMS DID THE TRAINEE..? 1. Ensure the casts are free of voids and nodules 2. Blockout casts to zero degrees 3. Apply acrylic resin to casts, reaching an optimal thickness 4. Ensure the acrylic resin is dense and completely cured 5. Carefully remove the cured record bases from the cast without breakage or warpage 6. Finish and smooth record base borders, ensuring denture bearing areas are covered 7. Trim the record bases to desired thickness and design length 8. Adapt and modify wax rims to proper dimensions and ensure final product is polished 9. Disinfect record bases FEEDBACK: Using this checklist as a source of information, discuss the trainee's performance indicating strengths and weaknesses, suggested improvements, etc. If the trainee performed all steps of the task satisfactorily, both the trainer and trainee should certify performance by appropriately documenting the OJT record. YES NO

INSTRUCTIONS: The trainee must be able to select the proper artificial tooth by shade and mold as prescribed by the provider. The trainee must be able to achieve a setup incorporating proper compensating curve and buccal alignment. The trainee must satisfactorily perform all parts of the task without assistance. Ensure proper safety precautions are followed. Evaluate the trainee’s performance using this checklist. ARRANGING TEETH FOR BILATERAL BALANCED OCCLUSION DID THE TRAINEE…? 1. Ensure the casts were accurately mounted 2. Select the correct shade and mold of artificial tooth as prescribed by the provider 3. Verify the alignment of the midline between maxillary and mandibular teeth 4. Set the central sulcus of maxillary posterior teeth over the crest of the lower ridge 5. Set mandibular posterior teeth for correct working, balancing, and protrusive contacts 6. Arrange mandibular anteriors for optimum function and esthetics 7. Perform a final check on the occlusion to verify occlusal scheme FEEDBACK: Using this checklist as a source of information, discuss the trainee's performance indicating strengths and weaknesses, suggested improvements, etc. If the trainee performed all steps of the task satisfactorily, both the trainer and trainee should certify performance by appropriately documenting the OJT record. YES NO

INSTRUCTIONS: The trainee must be able to select the proper artificial tooth by shade and mold as prescribed by the provider. The trainee must be able to achieve a setup for monoplane occlusion and incorporate proper buccal alignment. The trainee must satisfactorily perform all parts of the task without assistance. Ensure proper safety precautions are followed. Evaluate the trainee’s performance using this checklist. ARRANGING TEETH FOR MONOPLANE OCCLUSION DID THE TRAINEE…? 1. Ensure the casts were accurately mounted 2. Select the correct shade and mold of artificial tooth as prescribed by the provider 3. Arrange maxillary and mandibular anteriors for optimum function and esthetics 4. Verify the alignment of the midline between maxillary and mandibular teeth 5. Set the buccal cusps of mandibular posterior teeth over the crest of the lower ridge 6. Set maxillary posterior teeth for maximum intercuspation and sufficient horizontal overlap to prevent cheek biting 7. Perform a final check on the occlusion to verify occlusal scheme FEEDBACK: Using this checklist as a source of information, discuss the trainee's performance indicating strengths and weaknesses, suggested improvements, etc. If the trainee performed all steps of the task satisfactorily, both the trainer and trainee should certify performance by appropriately documenting the OJT record. YES NO

INSTRUCTIONS: The trainee must be able to select the proper artificial tooth by shade and mold as prescribed by the provider. The trainee must be able to achieve a setup for crossbite occlusion and incorporate proper buccal alignment. The trainee must satisfactorily perform all parts of the task without assistance. Ensure proper safety precautions are followed. Evaluate the trainee’s performance using this checklist. ARRANGING TEETH FOR CROSSBITE OCCLUSION DID THE TRAINEE…? 1. Ensure the casts were accurately mounted 2. Select the correct shade and mold of artificial tooth as prescribed by the provider 3. Arrange maxillary and mandibular anteriors for optimum function and esthetics 4. Verify the alignment of the midline between maxillary and mandibular teeth 5. Set the central sulcus of mandibular posterior teeth over the crest of the lower ridge 6. Set maxillary posterior teeth for maximum intercuspation and sufficient negative horizontal overlap to prevent cheek biting 7. Perform a final check on the occlusion to verify occlusal scheme FEEDBACK: Using this checklist as a source of information, discuss the trainee's performance indicating strengths and weaknesses, suggested improvements, etc. If the trainee performed all steps of the task satisfactorily, both the trainer and trainee should certify performance by appropriately documenting the OJT record. YES NO

30________________________________________________VOLUME 3 MODULE 10. ARRANGING TEETH FOR OPPOSING NATURAL DENTITION PERFORMANCE CHECKLIST
INSTRUCTIONS: The trainee must be able to select the proper artificial tooth by shade and mold as prescribed by the provider. The trainee must be able to set artificial teeth against natural dentition. The trainee must satisfactorily perform all parts of the task without assistance. Ensure proper safety precautions are followed. Evaluate the trainee’s performance using this checklist. ARRANGING TEETH FOR OPPOSING NATURAL DENTITION DID THE TRAINEE…? 1. Ensure the casts were accurately mounted 2. Select the correct shade and mold of artificial tooth as prescribed by the provider 3. Arrange maxillary anteriors for optimum function and esthetics 4. Verify placement of the midline 5. Set maxillary posterior teeth with sufficient horizontal overlap to prevent cheek biting 6. Selective grind occlusion for maximum intercuspation 7. Perform a final check on the occlusion to verify occlusal scheme FEEDBACK: Using this checklist as a source of information, discuss the trainee's performance indicating strengths and weaknesses, suggested improvements, etc. If the trainee performed all steps of the task satisfactorily, both the trainer and trainee should certify performance by appropriately documenting the OJT record. YES NO

MODULE 11. ARRANGING TEETH FOR LINGUALIZED OCCLUSION PERFORMANCE CHECKLIST
INSTRUCTIONS: The trainee must be able to select the proper artificial tooth by shade and mold as prescribed by the provider. The trainee must be able to achieve a setup for lingualized occlusion and incorporate proper buccal alignment. The trainee must satisfactorily perform all parts of the task without assistance. Ensure proper safety precautions are followed. Evaluate the trainee’s performance using this checklist. ARRANGING TEETH FOR LINGUALIZED OCCLUSION DID THE TRAINEE…? 1. Ensure the casts were accurately mounted 2. Select the correct shade and mold of artificial tooth as prescribed by the provider 3. Arrange maxillary and mandibular anteriors for optimum function and esthetics 4. Verify the alignment of the midline between maxillary and mandibular teeth 5. Set the central sulcus of mandibular posterior teeth over the crest of the lower ridge 6. Set maxillary posterior teeth, ensuring lingual cusps contact mandibular central fossa 7. Raise maxillary buccal cusps of posterior teeth 8. Perform a final check on the occlusion to verify occlusal scheme FEEDBACK: Using this checklist as a source of information, discuss the trainee's performance indicating strengths and weaknesses, suggested improvements, etc. If the trainee performed all steps of the task satisfactorily, both the trainer and trainee should certify performance by appropriately documenting the OJT record. YES NO

INSTRUCTIONS: The trainee must be able to wax complete denture bases and satisfactorily perform all parts of the task without assistance. Ensure proper safety precautions are followed. Evaluate the trainee’s performance using this checklist. WAXING COMPLETE DENTURE BASES DID THE TRAINEE…? 1. Remove the palate without breakage and accurately reseat the denture on the cast 2. Replace the palate with wax or preformed palate, producing a uniform thickness 3. Recheck the occlusion and make any necessary adjustments to return the denture teeth to the prescribed occlusal relationship 4. Bulk wax dentures to provide adequate wax thickness for contouring 5. Carve gingival trim and root eminences to simulate natural tissue contours without creating food traps 6. Shape the labial flanges to allow for the lips, cheeks and tongue 7. Smooth the waxup and redefine the gingival trim, ensuring removal of all excess wax from the denture teeth FEEDBACK: Using this checklist as a source of information, discuss the trainee's performance indicating strengths and weaknesses, suggested improvements, etc. If the trainee performed all steps of the task satisfactorily, both the trainer and trainee should certify performance by appropriately documenting the OJT record. YES NO

STEPS IN TASK PERFORMANCE: 1. Apply separating medium to cast and flask 2. Prepare stone mixture to creamy consistency and pour in lower half of flask 3. Place cast in stone, pouring additional stone to land area of cast 4. Smooth surface of stone to eliminate all undercuts 5. Allow stone mix to set until firm 6. Apply separating medium to stone surface 7. Prepare stone mixture using vacuum mixer and pour upper half of flask to occlusal of teeth 8. Create a trough in tongue space of second pour to ease deflasking 9. Allow mix to set until hard and apply separating medium to stone surface 10. Cap with stone mix, slightly overfilling flask and place lid on flask 11. Allow stone to set and clean excess stone from exterior of flask 12. Submerge flask in boil-out unit for 5 minutes 13. Open mold using deflasking chisel 14. Remove any solid wax from mold using a dental waxing instrument 15. Flush out remaining wax from each flask half using metal ladle or available pump system 16. Scrub out mold halves using brush and detergent 17. Rinse out mold halves with clean water by ladle or pump method 18. Return maxillary lower half of flask to dentist for designing posterior palatal seal area 19. Carve posterior palatal seal to prescribed width and depth if not done previously 20. Grind diatorics in ridge lap portion of acrylic denture teeth 21. Apply separating medium to stone areas of mold 22. Ensure separating medium does not touch ridge lap area of acrylic teeth 23. Measure and mix and acrylic resin IAW manufacturer’s instructions 24. Roll and flatten resin dough, and cut into strips 25. Press strips gently into upper flask covering teeth and denture base 26. Place 2 plastic packing sheets over acrylic areas 27. Replace opposite flask half and place flask in flask press 28. Apply appropriate pressure to flask IAW manufacturer's instructions 29. Separate two halves of flask and remove packing sheets 30. Remove excess acrylic using blunt edged instrument 31. Trial pack the mold at least two times or until flash no longer appears 32. Perform final closure of flask with no packing sheets 33. Place flask in flask carrier 34. Submerge carrier in curing unit and cure acrylic resin IAW manufacturer's instructions

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MODULE 13. PROCESSING COMPLETE DENTURE BASES PERFORMANCE CHECKLIST
INSTRUCTIONS: The trainee must be able to process complete denture bases and satisfactorily perform all parts of the task without assistance. Ensure proper safety precautions are followed. Evaluate the trainee’s performance using this checklist. PROCESSING COMPLETE DENTURE BASES DID THE TRAINEE…? 1. Properly prepare the flask and cast by applying separator 2. Pour lower half of flask without incorporating undercuts in the stone 3. Pour upper half of flask and stone cap, ensuring separator was applied between each new stone mixture 4. Heat the flask in boiling water for 5-6 minutes and separate the flask halves without breakage 5. Thoroughly clean the flask halves with detergent and flush with clean hot water 6. Carve the posterior palatal seal into the maxillary cast following the dentists design 7. Clean ridge laps of the teeth with monomer 8. Mix acrylic resin according to manufacturer’s directions 9. Allow resin dough to reach packing consistency and properly roll/flatten to align fibers 10. Trial pack the mold at least two times, or until achieving metal to metal contact between the flask halves with minimal flash of acrylic 11. Final close the flask without a plastic sheet, place in flask carrier and tighten press 12. Place the flask/flask carrier assembly in curing unit and cure in accordance with manufacturer’s directions YES NO

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FEEDBACK: Using this checklist as a source of information, discuss the trainee's performance indicating strengths and weaknesses, suggested improvements, etc. If the trainee performed all steps of the task, both the trainer and trainee should certify performance by appropriately documenting the OJT record.

STEPS IN TASK PERFORMANCE: 1. Remove flask from curing unit and bench cool to room temperature 2. Remove flask from flask carrier 3. Remove flask cover and place flask in flask ejector 4. Place deflasking chisels into flask ejector slots 5. Press or push downward on deflasking chisels to separate flask from stone mold 6. Invert flask ejector and repeat separation procedures 7. Remove mold and flask from flask ejector 8. Make cuts in heel and cuspid area to remove denture and cast from mold 9. Ensure denture is not damaged 10. Remove stone from palate or tongue area of denture using air chisel 11. Clear remaining stone from cast using plaster knife 12. Clean base of cast and mounting 13. Attach cast to articulator mounting using hot compound material 14. Ensure cast/mounting junction line is not completely covered and cast is fully seated 15. Adjust articulator settings to duplicate previous settings 16. Place black articulating paper on left and right sides of denture and disclose high spots 17. Achieve maximum intercuspation (MI) by grinding fossae, proximal marginal ridges, and cusp inclines of denture using bur 18. Repeat disclosing and grinding procedures until incisal guide pin touches guide table 19. Place red articulating paper on left and right sides of denture 20. Slide upper member of articulator to right and left 21. Reduce excursive markings by grinding until working and balancing contacts are achieved 22. Place red articulating paper on left, right, and anterior of denture 23. Slide upper member of articulator to rear 24. Reduce protrusive markings by grinding until posterior tooth contact is achieved with simultaneous anterior tooth contact 25. Apply mill-in paste to occlusal surfaces of teeth 26. Slide upper member through excursive movements to duplicate chewing cycle 27. Clean dentures using soap and water

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MODULE 15. RESTORING THE OCCLUSION OF PROCESSED COMPLETE AND REMOVABLE PARTIAL DENTURES PERFORMANCE CHECKLIST
INSTRUCTIONS: The trainee must be able to deflask, remount and perform selective grinding procedures and satisfactorily perform all tasks without assistance. Ensure proper safety precautions are followed. Evaluate the trainee’s performance using this checklist. RESTORING THE OCCLUSION OF PROCESSED COMPLETE AND REMOVABLE PARTIAL DENTURES DID THE TRAINEE…? 1. Remove the flask from the curing unit and allow to bench cool to room temperature 2. Recover the processed denture/cast from the mold without damaging the denture or cast 3. Accurately remount the cast 4. Restore vertical dimension of occlusion ensuring all contacts are equally distributed when incisal guide pin touches the incisal table 5. Restore working/balancing contacts equally, ensuring left/right eccentric contacts are evenly distributed 6. Restore protrusive contacts equally ,ensuring positive anterior/posterior contacts exists in both areas 7. Apply milling paste to occlusal surfaces of teeth and slide through excursive movements, duplicating the chewing cycle 8. Clean excess milling paste from the teeth and denture base FEEDBACK: Using this checklist as a source of information, discuss the trainee's performance indicating strengths and weaknesses, suggested improvements, etc. If the trainee performed all steps of the task satisfactorily, both the trainer and trainee should certify performance by appropriately documenting the OJT record. YES NO

48________________________________________________VOLUME 3 MODULE 16. CONSTRUCTING REMOUNTING INDICES AND REMOUNT CASTS PERFORMANCE CHECKLIST
INSTRUCTIONS: The trainee must be able to construct remounting indices/index and remount casts and satisfactorily perform all tasks without assistance. Ensure proper safety precautions are followed. Evaluate the trainee’s performance using this checklist. HOW TO CONSTRUCT REMOUNTING INDICES/INDEX AND REMOUNT CASTS DID THE TRAINEE…? 1. Properly prepare the articulator by removing the mandibular mounting and attaching the remounting table 2. Construct the remounting index by slightly embedding the incisal edges and cusp tips in the patty, ensuring the incisal guide pin contacts the table 3. Prepare the denture by blocking out all tissue undercuts and placing beading wax around the peripheral border 4. Gently seat the denture into a stone patty to index the peripheral roll 5. Trim the stone patty to approximately 3 mm from the peripheral roll indentations 6. Lute the denture to both the cast and remounting index, and accurately mount the cast 7. Remove sticky wax and disinfect the completed denture FEEDBACK: Using this checklist as a source of information, discuss the trainee's performance indicating strengths and weaknesses, suggested improvements, etc. If the trainee performed all steps of the task satisfactorily, both the trainer and trainee should certify performance by appropriately documenting the OJT record. YES NO

STEPS IN TASK PERFORMANCE: 1. Separate denture from cast using air chisel or lab saw 2. Trim off excess stone and acrylic resin using bur and handpiece/bench lathe 3. Remove any sharp spots from tissue area 4. Place denture identification on external (cameo) surface--lingual flange of mandibular/palatal of maxillary 5. Remove scratches using polishing lathe with wet rag wheel and pumice 6. Rinse denture under running water to remove excess pumice 7. Polish denture with polishing compound using rag wheel 8. Place denture in ultrasonic cleaner after polishing to remove polishing compound 9. Disinfect denture, store in a humid environment

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MODULE 17.

FINISHING AND POLISHING COMPLETE DENTURES PERFORMANCE CHECKLIST

INSTRUCTIONS: The trainee must be able to finish and polish complete dentures and satisfactorily perform all tasks without assistance. Ensure proper safety precautions are followed. Evaluate the trainee’s performance using this checklist. FINISHING AND POLISHING COMPLETE DENTURES DID THE TRAINEE…? 1. Separate the denture bases from the cast without damaging the acrylic resin 2. Remove flash and correct denture contours 3. Properly place patient ID and smooth the denture bases without altering contours or tooth anatomy 4. Polish the denture bases, producing a smooth, hygienic surface 5. Clean and disinfect the completed dentures FEEDBACK: Using this checklist as a source of information, discuss the trainee's performance indicating strengths and weaknesses, suggested improvements, etc. If the trainee performed all steps of the task satisfactorily, both the trainer and trainee should certify performance by appropriately documenting the OJT record. YES ` NO

INSTRUCTIONS: The trainee must be able to fabricate immediate dentures and satisfactorily perform all parts of the task without assistance. Ensure proper safety precautions are followed. Evaluate the trainee’s performance using this checklist. FABRICATING IMMEDIATE DENTURES DID THE TRAINEE…? 1. Remove and replace the anterior teeth one at a time, preserving the proximal contacts and duplicating the original axial inclinations 2. Remove the posterior teeth and arrange the denture teeth in the prescribed occlusal relationship 3. Wax gingival margins and root eminences to simulate natural tissue contours without creating food traps 4. Shape the labial and lingual flanges to allow for the natural drape of the lips, cheeks and tongue 5. Smooth the wax and re-define the gingival trim, ensuring removal of all excess wax from the denture teeth 6. Verify the occlusion 7. Flask and boilout the denture mold, and make a duplicate cast to process the surgical template 8. Process acrylic resin into the denture and surgical template molds following the manufacturer’s directions for mixing, packing, and curing 9. Deflask the denture without breakage, remount and re-establish the prescribed occlusal relationship 10. Place patient ID, finish and polish the denture base and surgical template, to refine contours and produce a smooth, hygienic surface 11. Clean and disinfect the completed denture and surgical template YES NO

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FEEDBACK: Using this checklist as a source of information, discuss the trainee's performance indicating strengths and weaknesses, suggested improvements, etc. If the trainee performed all steps of the task satisfactorily, both the trainer and trainee should certify performance by appropriately documenting the OJT record.

MODULE 19. FABRICATING RPD DENTURE BASES PERFORMANCE CHECKLIST
INSTRUCTIONS: The trainee must be able to fabricate RPD bases and satisfactorily perform all parts of the task without assistance. Ensure proper safety precautions are followed. Evaluate the trainee’s performance using this checklist. FABRICATING RPD DENTURE BASES DID THE TRAINEE…? 1. Raise the incisal guide pin 0.5 mm 2. Set the denture teeth in the prescribed occlusal relationship 3. (if applicable) Stabilize the tissue stop from occlusal (vertical forces) 4. Return the incisal guide pin to its original position and grind the denture teeth into maximum intercuspation ensuring at least 1mm horizontal overlap with the pin in contact with the incisal guide table 5. Wax the denture base areas to simulate natural tissue contours 6. Flask the RPD without incorporating undercuts in the lower half flask and boilout the mold without breakage 7. Mix, split pack and cure the acrylic resin following the manufacturer’s directions 8. Deflask the processed RPD without breakage, remount and correct the processing errors 9. Remove the RPD from the cast, ensuring the framework is not distorted and the acrylic resin is not fractured 10. Place patient ID and finish and polish the RPD to refine the contours and create a smooth, hygienic surface 11. Clean and disinfect the finished RPD FEEDBACK: Using this checklist as a source of information, discuss the trainee's performance indicating strengths and weaknesses, suggested improvements, etc. If the trainee performed all steps of the task satisfactorily, both the trainer and trainee should certify performance by appropriately documenting the OJT record. YES NO

58________________________________________________VOLUME 3 MODULE 20. RELINING REMOVABLE PROSTHESES
STS TASK REFERENCE(S): 6g Reline removable prostheses TRAINING REFERENCE(S): AFP 162-6, Vol 2, Dental Laboratory Technology EVALUATION INSTRUCTIONS: Demonstrate how to properly reline a maxillary or mandibular removable prosthesis. Ensure that the trainee disinfects the prosthesis prior to working on it. Stress the need for taking care when boxing the prosthesis to prevent distorting the new impression material. When an RPD is being relined be careful not to bury delicate parts of the RPD in the stone. Stress that a clean surface needs to be achieved to ensure proper bonding of the new acrylic resin. Stress the importance of tightening the jig until metal-to-metal contact is achieved. Have the trainee perform reline procedures and suggest ways to improve performance. After ensuring the trainee has received sufficient practice, evaluate his/her abilities using the performance checklist. PERFORMANCE RESOURCES: Acrylic Resin Boxing Wax Bur Cotton-Tipped Applicator Polishing Compound Pumice Separating Medium Sticky Wax Vacuum Mixer Vibrator Patient ID Material Finishing and Polishing Wheels

INSTRUCTIONS: The trainee must be able to accurately reline a removable prosthetic appliance and satisfactorily perform all parts of the task without assistance. Ensure proper safety precautions are followed. Evaluate the trainee’s performance using this checklist. RELINING REMOVABLE PROSTHESES DID THE TRAINEE...? 1. Disinfect the appliance prior to working on it 2. Pour the impression, producing an accurate master cast 3. Accurately mount the prosthesis in the reline jig, ensuring metal to metal contact between the jig halves 4. Carefully remove the prosthesis from the cast and prepare the cast for packing procedures 5. Remove all impression material from the prosthesis and create a butt joint at periphery 6. Securely fasten the prosthesis to the lower member of the jig 7. Apply separator to all acrylic resin contact areas 8. Properly mix and apply the acrylic resin to the prepared denture base 9. Correctly reassemble and tighten the jig 10. Submerge the assembly in a pressure pot to cure the acrylic resin 11. Carefully remove the prosthesis from the cast without breaking or warping acrylic resin 12. Place patient ID and finish and polish the prosthesis 13. Disinfect the prosthesis FEEDBACK: Using this checklist as a source of information, discuss the trainee's performance indicating strengths and weaknesses, suggested improvements, etc. If the trainee performed all steps of the task satisfactorily, both the trainer and trainee should certify performance by appropriately documenting the OJT record. YES NO

PERFORMANCE CHECKLIST
INSTRUCTIONS: The trainee must be able to rebase complete dentures and satisfactorily perform all parts of the task without assistance. Ensure proper safety precautions are followed. Evaluate the trainee’s performance using this checklist. REBASING COMPLETE DENTURES DID THE TRAINEE…? 1. Disinfect the denture and accurately pour the rebase cast 2. Augment the denture base contours to produce a natural appearance and promote denture retention 3. Flask the denture, ensuring facial/lingual flanges were coated with polyvinyl siloxane material and occlusal surfaces were indexed in stone 4. Separate the flask halves without breakage and carefully remove the denture from the rebase cast 5. Grind the denture base material from the teeth without altering the tooth contours 6. Accurately reseat the denture teeth in the upper half of the flask and apply separator 7. Mix, pack and cure the acrylic resin IAW manufacturer’s directions 8. Deflask the processed denture and remove from the cast without fracturing the denture 9. Place patient ID and finish and polish the denture to refine the contours and provide a smooth hygienic surface 10. Clean and disinfect the denture FEEDBACK: Using this checklist as a source of information, discuss the trainee's performance indicating strengths and weaknesses, suggested improvements, etc. If the trainee performed all steps of the task satisfactorily, both the trainer and trainee should certify performance by appropriately documenting the OJT record. YES NO

STEPS IN TASK PERFORMANCE: 1. Refer to DD form 2322 for instructions ( shade and mold) 2. Select artificial tooth for proper mold and shade 3. Mark ridge and proximal areas for selective grinding 4. Grind tooth for proper contour and wax into position 5. Apply separator to RAP area 6. Mix stone and apply to RAP area to fabricate matrix 7. Allow stone to set and remove matrix from cast 8. Trim matrix, using knife or lathe 9. Remove wax from stone cast 10. Verify proper fit 11. Disinfect and store in a humid environment

VOLUME 3

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MODULE 22.

PREPARING REINFORCED ACRYLIC PONTICS PERFORMANCE CHECKLIST

INSTRUCTIONS: The trainee must be able to fabricate reinforced acrylic pontics for removable partial dentures and satisfactorily perform all parts of the task without assistance. Ensure proper safety precautions are followed. Evaluate the trainee’s performance using this checklist. PREPARING REINFORCED ACRYLIC PONTICS DID THE TRAINEE…? 1. Select proper shade and mold of tooth 2. Mark the cast and grind tooth for proper contour and fit 3. Wax tooth into position, apply separator to the cast and fabricate stone matrix 4. Clean wax from the stone cast 5. Verify accuracy of the fit between the RAP, stone matrix, and the cast FEEDBACK: Using this checklist as a source of information, discuss the trainee's performance indicating strengths and weaknesses, suggested improvements, etc. If the trainee performed all steps of the task satisfactorily, both the trainer and trainee should certify performance by appropriately documenting the OJT record. YES NO

STEPS IN TASK PERFORMANCE: 1. Disinfect impression 2. Stabilize orthodontic band to alginate impression 3. Pour artificial stone into impression without disturbing band position 4. Separate cast from impression without disturbing band position 5. Adapt orthodontic wire to form cantilever loop 6. Sticky wax loop into position on cast and cover wire with stone, except in band/wire junction area 7. Remove sticky wax and ensure wire is in contact with band 8. Adjust orthodontic soldering torch to maximize reducing portion of flame 9. Place flux in solder area and solder loop to band using silver solder 10. Bulk finish soldered appliance on cast using stones and rubber points 11. Remove appliance from cast with care 12. Finish and polish appliance using stones and rubber points 13. Disinfect appliance and store in a humid environment

68________________________________________________VOLUME 3 MODULE 23. FABRICATING CANTILEVER LOOP SPACE MAINTAINERS PERFORMANCE CHECKLIST
INSTRUCTIONS: The trainee must be able to fabricate cantilever loop space maintainers and satisfactorily perform all parts of the task without assistance. Ensure proper safety precautions are followed. Evaluate the trainee’s performance using this checklist. FABRICATING CANTILEVER LOOP SPACE MAINTAINERS DID THE TRAINEE…? 1. Disinfect the impression and construct the cast without disturbing the band 2. Adapt the orthodontic wire evenly across the facial and lingual surfaces of the band 3. Adapt the stone matrix without covering the solder area or disturbing the wire 4. Accurately solder the wire to the band without porosity 5. Finish solder joints without compromising strength 6. Smooth and polish the solder joints to a high luster 7. Clean and disinfect the appliance FEEDBACK: Using this checklist as a source of information, discuss the trainee's performance indicating strengths and weaknesses, suggested improvements, etc. If the trainee performed all steps of the task satisfactorily, both the trainer and trainee should certify performance by appropriately documenting the OJT record. YES NO

70________________________________________________VOLUME 3 MODULE 24. FABRICATING HAWLEY RETAINERS PERFORMANCE CHECKLIST
INSTRUCTIONS: The trainee must be able to accurately fabricate a maxillary or mandibular Hawley retainer and satisfactorily perform all parts of the task without assistance. Ensure proper safety precautions are followed. Evaluate the trainee’s performance using this checklist. FABRICATING HAWLEY RETAINERS DID THE TRAINEE…? 1. Properly block out the cast 2. Adapt the proper size wire to the cast following the providers instructions 3. Apply separator and sprinkle the acrylic resin to adequate thickness and coverage 4. Completely cure the acrylic resin 5. Separate the appliance without warping or breaking it 6. Finish the appliance to a uniform thickness without damaging the wires 7. Polish the appliance creating a smooth, hygienic surface 8. Disinfect the appliance FEEDBACK: Using this checklist as a source of information, discuss the trainee's performance indicating strengths and weaknesses, suggested improvements, etc. If the trainee performed all steps of the task satisfactorily, both the trainer and trainee should certify performance by appropriately documenting the OJT record. YES NO